Role of nitric oxide in the visible light-induced rapid increase of human skin microcirculation at the local and systemic level: I. diabetic patients.

OBJECTIVE: This study aimed to reveal the effects of polychromatic visible (pVIS) or pVIS + near IR (nIR) light similar to some components of solar light on skin microcirculation and microvascular response to the vasodilatators acetylcholine (ACh) and nitroglycerine (NG), in the extremities of patients with diabetic microangiopathy. BACKGROUND DATA: The mechanisms behind light-induced increases in microcirculation as well as extracellular effects of terrestrial pVIS and pVIS + nIR light remain unknown. MATERIALS AND METHODS: In 24 subjects with type 2 diabetes mellitus local microcirculation was measured in the skin of the foot before and after exposure to both types of light. In another 26 patients systemic microcirculation was studied in the back of the hand before and after exposure of the lumbar-sacral area to light energy. Two different types of light therapy were performed by using two devises: Q-light, which delivers pVIP (385-750 nm) and pVIS nIR light (385-1700 nm) with a power density of 40 mW/cm2, which is similar to summer sunlight at noon in Central Europe. RESULTS: At 2 min after irradiation (12 J/cm2) of the forefoot with pVIS or pVIS + nIR light, a rise in local blood flow volume (Qas) was observed, on average by 39% and 31%, respectively. The maximal effect (+41-47%) had developed in all patients at 30 min, and it then decreased and disappeared completely 24 h post-irradiation. We obtained similar results after irradiation of the sacral area in Qas of the skin of the hand. Both types of microcirculation also increased following a second exposure to the light sources. Enhancement of microcirculation was accompanied by a decrease in the microvascular response to ACh and NG solutions administered intracutaneously by iontophoresis. CONCLUSION: Both types of irradiation stimulated microcirculation at the local and systemic levels through a mechanism of enhancement of endothelium-dependent and endothelium-independent vasodilation, in which nitric oxide plays a major role.

Vascular brachytherapy using a beta emitter source in diabetic patients with in-stent restenosis: angiographic and clinical outcomes.

PURPOSE: The management of diabetic patients with restenosis after percutaneous coronary intervention remains a significant challenge. Diabetic patients remain at significant risk of restenosis despite stent implantation. This retrospective analysis was performed to determine the extent to which vascular brachytherapy improves late clinical and angiographic outcomes in diabetic patients compared to conventional therapy and compared to patients' nondiabetic counterparts. METHODS: Pooled data from two studies (START [Stents and Radiation Trial] and START-40 trials) of patients (204 diabetic, 477 nondiabetic) receiving vascular brachytherapy (VBT) with a (90)Sr/(90)Y source after conventional percutaneous coronary intervention for in-stent restenosis comprise the study population. The radiation delivery system used in both studies was the Beta-Cath system. The prescribed dose at 2 mm from the centerline of the source axis was 18.4 Gy or 23 Gy, depending on vessel diameter. The reference vessel diameter, minimal lumen diameter, and percent diameter stenosis were measured before the intervention, at the conclusion of the procedure, and at the 8-month follow-up examination. The Breslow-Day test was used to formally assess the similarity of treatment effect between diabetic and nondiabetic patients. RESULTS: Target lesion and target vessel revascularization rates and angiographic restenosis rates in diabetic and nondiabetic patients treated with beta radiation or placebo were analyzed. Diabetic patients were more likely to have longer and more complex coronary lesions. In-hospital outcomes in diabetic and nondiabetic patients were similar, irrespective of treatment status. At 8 months, patients treated with beta radiation exhibited less target lesion revascularization (diabetic: 10.9% vs. 22.7%, p = 0.02; nondiabetic: 12.8% vs. 22.3%, p = 0.007) and less target vessel revascularization (diabetic: 14.7% vs. 25.3%, p = 0.06; nondiabetic: 16.6% vs. 23.6%, p = 0.06) compared to placebo. In-stent binary angiographic restenosis was lower in irradiated patients (diabetic: 19.4% vs. 37.3% for placebo, p = 0.01; nondiabetic: 12.9% vs. 43% for placebo, p < 0.001). However, restenosis beyond the stent site reduced the impact of VBT, regardless of diabetic status. The magnitude of the treatment effect for target lesion and target vessel revascularization rates was similar between diabetic and nondiabetic patients. CONCLUSIONS: Previously published institutional experiences have suggested that diabetic patients benefit from the use of VBT in the management of in-stent restenosis. This analysis now provides direct evidence to support the role of beta radiation VBT in this patient population. Diabetic patients undergoing this therapy are just as likely to benefit from it as their nondiabetic counterparts.

[Use of physical factors in the complex therapy of patients with diabetic angio- and polyneuropathies of the lower extremities]. / Primenenie fizicheskikh faktorov v kompleksnom lechenii bol'nykh s angio- i polinevropatiei nizhnikh konechnostei.

Results are submitted of treatment of 110 patients with diabetes mellitus (61 male and 49 female subjects) presenting with angio- and polyneuropathies of the lower extremities. 70 patients, in addition to a drug therapy, were administered physiotherapeutic treatments, such as amplipulsetherapy, darsonvalization, and laserotherapy. Forty patients received medicamentous therapy only. Based on clinical findings and laboratory methods of investigation expediency has been shown of employment of physiotherapeutic methods in the treatment of the above pathology.

Systemic effects of low-intensity laser irradiation on skin microcirculation in patients with diabetic microangiopathy.

Low-intensity laser irradiation has been shown to induce wound healing in conditions of reduced microcirculation, which is in part explained by systemic effects. We therefore investigated such a potential systemic effect of low-intensity laser irradiation on skin blood circulation in patients with diabetic microangiopathy. Patients with diabetic microangiopathy were randomized to receive either a single helium-neon (HeNe, 632.8 nm) low-intensity laser irradiation with a dose of 30 J/cm(2) or a sham irradiation over the forefoot region in a double-blind, placebo-controlled clinical study. Skin blood circulation by means of temperature recordings over forefoot regions was detected by infrared thermography. Following a single transcutaneous low-intensity laser irradiation, a rise in skin temperature in both feet of the subjects in the laser group was noted, whereas in both feet of the subjects in the placebo group a drop in skin temperature occurred. The baseline-adjusted skin temperature 15 min after the end of the irradiation was significantly higher in the laser-treated forefeet compared to the placebo-"treated" forefeet (p < 0.0001); the baseline-adjusted difference in the temperature was 1.94 +/- 0.35 degrees C. Simultaneously, the baseline-adjusted skin temperature was significantly higher in the laser-untreated forefeet compared to the placebo-"untreated" forefeet (P < 0.0001); the baseline-adjusted difference was 1.70 +/- 0.33 degrees C. Our data show a significant increase in skin circulation due to athermic laser irradiation in patients with diabetic microangiopathy and point to the possibility of inducing systemic effects.

The effect of intracoronary radiation for the treatment of recurrent in-stent restenosis in patients with diabetes mellitus.

OBJECTIVES: The purpose of this study was to examine the effect of intracoronary radiation therapy (IRT) in diabetic patients with in-stent restenosis (ISR). BACKGROUND: Diabetic patients are at an increased risk for restenosis, repeat revascularization procedures and late mortality after percutaneous coronary interventions and stenting. Intracoronary radiation therapy, utilizing both gamma and beta-emitters, has been shown to reduce the rate of ISR. METHODS: The study group consisted of 749 consecutive patients with ISR who were treated with either IRT or placebo in randomized trials and registries at our center. Diabetic patients (252 radiation and 51 placebo) were compared with nondiabetic patients (371 radiation and 75 placebo). RESULTS: In-hospital outcomes were similar between diabetic and nondiabetic patients treated with and without radiation. At six-month clinical and angiographic follow-up, there was a significant reduction in the binary restenosis (63.8% vs. 15.7%, p < 0.0001), target lesion revascularization (66.7% vs. 17.6%, p < 0.0001) and target vessel revascularization (TVR) (70.6% vs. 22.9%, p < 0.0001) rates in diabetic patients treated with radiation compared to placebo. Comparisons between the placebo arms detected a trend towards higher restenosis (63.8% vs. 48.4% p = 0.13) and TVR (70.6% vs. 56.0%, p = 0.14) in diabetic versus nondiabetic patients. In contrast, diabetic and nondiabetic patients treated with IRT experienced similar restenosis (15.6% vs. 10.7% p = 0.33) and TVR (22.9% vs. 28.2% p = 0.41) rates. CONCLUSIONS: In diabetic patients with ISR, intracoronary radiation significantly reduced the recurrence of ISR compared to placebo. Additionally, similar rates of restenosis and revascularization procedures were achieved in irradiated diabetic and nondiabetic patients. In view of these results, IRT should be considered as a valuable therapeutic alternative in all diabetic patients with ISR.

Low-intensity laser irradiation improves skin circulation in patients with diabetic microangiopathy.

OBJECTIVE: Diabetic foot problems due to angiopathy and neuropathy account for 50% of all nontraumatic amputations and constitute a significant economic burden to society. Low-intensity laser irradiation has been shown to induce wound healing in conditions of reduced microcirculation. We investigated the influence of low-intensity laser irradiation by means of infrared thermography on skin blood circulation in diabetic patients with diabetic microangiopathy. RESEARCH DESIGN AND METHODS: Thirty consecutive patients with diabetic ulcers or gangrenes and elevated levels of glycosylated hemoglobin were randomized by blocks of two to receive either a single low-intensity laser irradiation with an energy density of 30 J/cm2 or a sham irradiation over both forefoot regions in a double-blind placebo-controlled clinical study. Skin blood circulation as indicated by temperature recordings over the forefoot region was detected by infrared thermography. RESULTS: After a single transcutaneous low-intensity laser irradiation, a statistically significant rise in skin temperature was noted (P < 0.001 by ANOVA for repeated measurements), whereas in the sham-irradiated control group, a slight but significant drop in temperature (P < 0.001) was found. Subsequently performed contrasts for comparison of measurements before and after irradiation revealed significant temperature increases at 20 min of irradiation time (P < 0.001), at the end of the irradiation (P < 0.001), and 15 min after stopping the irradiation (P < 0.001). In the sham-irradiated feet, the drop in local skin temperature was not significant at 20 min (P = 0.1), but reached significance at the end of the sham-irradiation procedure (P < 0.001) and 15 min after the end of sham irradiation (P < 0.001). CONCLUSIONS: The data from this first randomized double-blind placebo-controlled clinical trial demonstrate an increase in skin microcirculation due to athermic laser irradiation in patients with diabetic microangiopathy.

[Laser puncture in the treatment of diabetic angiopathies of the lower extremities]. / Lazeropunktura pri lechenii diabeticheskikh angiopatii nizhnikh konechnostei.

Laseropuncture in patients with diabetes mellitus associated with angiopathies of the lower extremities (grade II and III) produced a pronounced clinical effect which was manifested by removing the pain syndrome, improvement of the peripheral circulation and extremity function and function of the lower extremities, improvement of thermographic values. But this positive dynamics was more pronounced in angiopathies of the lower extremities of the stage of functional disorders than obliterating atherosclerosis of the legs. Sterility of the laser beam, possibility of local effect on biologically active points, non-painful procedure, absence of age limits and side effects allow to widely recommend this method for the treatment of Diabetes mellitus associated with angiopathies of the lower extremities.

[The use of helium-neon laser radiation in the treatment of trophic disorders in patients with diabetes mellitus]. / Primenenie izlucheniia gelii-neonovogo lazera v lechenii troficheskikh narushenii u bol'nykh sakharnym diabetom.

The effectiveness of laser therapy in trophic skin disorders (ulcer, diabetic bulla, hematoma, skin chap) in patients with diabetes mellitus was studied. The foci of trophic disorders and biologically active points were irradiated by means of heliumneon laser installations. The technique was employed in a hospital and in out-patient treatment in the complex with medicamentous therapy and without that in patients resistant to medicamentous therapy. A high effectiveness of laser therapy has been established.

[Effect of endovascular laser irradiation of the blood of patients with diabetic angiopathies]. / Effekt éndovaskuliarnogo lazernogo oblucheniia krovi u bol'nykh diabeticheskimi angiopatiiami.

The activity of primary and secondary products of lipid peroxidation and antiperoxide protection enzymes was investigated in 33 patients with diabetes mellitus, complicated by lower limb angiopathies before and after endovascular laser irradiation of blood. Tissue microcirculation was evaluated on the basis of the results of capillaroscopy and thermography of the limbs, and biomicroscopy of the conjunctiva. Blood was irradiated with the help of a light guide for 60 min. Laser therapy led to a decrease in the activity of processes of free radical oxidation, acting probably on antiperoxide protection enzymes. Tissue microcirculation was markedly improved.

[The treatment of diabetic angiopathies by endovascular low-intensity laser irradiation]. / Lechenie diabeticheskikh angiopatii éndovaskuliarnym nizkointensivnym lazernym oblucheniem.

A study was made of the effect of endovascular laser irradiation of the blood with a He-Ne laser on blood rheological properties, tissue microcirculation and leukocyte function in 28 patients suffering from diabetes mellitus with diabetic angiopathies. A course of endovascular laser irradiation of the blood resulted in the improvement of a clinical course of angiopathies, indices of biomicroscopy of the eye conjunctiva as well as capillaroscopy and thermogenic activity of the limbs. Blood viscosity was significantly decreased; noticeable stimulation of leukocyte beta-galactosidase from 16.4 +/- 3.4 up to 26.8 +/- 4.4 nmol/h was observed. A conclusion has been made that laser therapy leads to significantly improved tissue microcirculation and prevents the development of pathological vascular changes.

[Experiences with low-power laser therapy in internal medicine geriatrics]. / Erfahrungen mit der Low-power-Lasertherapie in der internistischen Geriatrie.

The use of low power laser therapy in 30 in-patients aged from 72 to 86 years suffering from diseases of the movement apparatus resistant to treatment and from chronic peripheral and cerebral circulation disorders based on arteriosclerosis is proofed as efficient, riskless physicaltherapy method to improve the complaints and to economize with medicamentation.